Gastric Bypass
The most commonly performed operation for morbid obesity in the United States is called gastric bypass. Other names for this procedure include Roux-N-Y gastric bypass or Roux-N-Y gastrojejunal bypass. This is one of the two operations approved by the National Institute of Health (NIH) consensus conference in 1991 for the treatment of morbid obesity.
The stomach is divided into a small upper part and a large lower part. The small upper part of the stomach now acts as a new stomach. This part of the stomach is also called the stomach pouch or gastric pouch. Usual size of the gastric pouch is 1 to 2 ounces after surgery. The size of an average stomach is equal to the size of a person's head, or 6 cups, and the size of the stomach pouch after gastric bypass is equal to the size of a person's thumb.
About one-third of the small intestine is bypassed, and 2" length of intestine is connected from the small stomach pouch to the rest of the intestines. The lower part of the stomach and its intestine will no longer be used. Roughly two-thirds of the small intestine is still used for digestion and absorption of food after food passes from the small stomach pouch into the small intestine.
Since the stomach holds less food, a person feels full after a very small meal. The connection between the gastric pouch and the small intestine is very small, and food tends to stay in the gastric pouch for a long duration, giving the person a feeling of fullness for several hours. Since a part of the small intestine is bypassed, all of the calories in the food are not absorbed. This method helps weight loss but still requires a change in lifestyle. This is one of the operations performed for weight loss at Hamot Medical Center.
Gastric bypass surgery has been performed for weight loss since the 1960s. The procedure was initially performed using an open incision. In the early 1990s, a laparoscopic technique to perform this operation was developed. During laparoscopic surgery, six tiny incisions are made to perform the operation. Surgeons insert long instruments through these tiny holes to perform the procedure. A camera is attached to one of these instruments. The camera shows a video image of the operation on a television monitor. The laparoscopic approach offers the advantages of smaller incisions, less pain and earlier recovery. There is also a lower incidence of ventral hernias (abdominal hernias) after laparoscopic gastric bypass compared with open gastric bypass. Since the exact same operation is performed during open and laparoscopic surgeries, other outcomes including weight loss are similar with both approaches. Both open and laparoscopic gastric bypass surgeries are performed at Hamot Medical Center . Laparoscopic gastric bypass cannot be performed in every patient. During your consultation, you will be able to find out if you qualify for a laparoscopic gastric bypass surgery.
Patients can expect to lose 40 percent to 75 percent of their excess weight throughout a period of 18 months after gastric bypass surgery. Over a five-year period, patients tend to regain 10 to 20 pounds. However, most people are able to lose a significant amount of weight and keep it off long term. Many factors influence weight loss after gastric bypass surgery. Younger patients, men and patients who are committed to making permanent lifestyle changes usually lose more weight. Individual weight loss results vary. Ten percent to 15 percent of patients lose less than 50 percent of their excess weight.
Risks of Gastric Bypass Surgery
Listed below are problems you need to think about before choosing gastric bypass surgery. The percent is the risk to you, based on how often each one has happened to other people having this surgery.
15-20%— Failure to lose much weight
15-20%— Psychiatric problems, like depression
15-20%— Likelihood of a complication
10%— Wound infection
2%— Stomach ulcer
Less than 2%— Severe lack of vitamins
Less than1%— Leaks or tears causing internal infection and need for more surgery
Rare— Too much weight loss
Rare— Blockage needing another surgery
0.5 to 1%— Death (based on a national average)
